
<div class="padding-20px Sendingdomainname-tips margin-bottom-30px text-size-14px text-color-e60000 " style="background-color: #F7F2F2;color: #e60000;font-size: 14px !important;margin-bottom: 30px;padding: 20px">
    <div class="text-weight-xl flex_box flex-align-items padding-bottom-10px">
        <span>注意事项</span></div>
    <div class="padding-left-25px  webkit-line-clamp2" style="line-height: 25px;">
        <span>提现到银行卡将会默认提现到您绑定的银行卡账户，如果需要修改，请金额。</span>

    </div>
</div>
<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">



    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-3">提现方式:</label>
        <div class="col-xs-12 col-sm-7">
            <select id="c-method" data-rule="required" class="form-control selectpicker" name="row[method]">
                <option  value="1">银行卡</option>
                <option  value="2">微信零钱</option>
            </select>
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-3">提现金额:</label>
        <div class="col-xs-12 col-sm-7">
            <input id="c-title" data-rule="required" class="form-control" name="row[money]" value="" type="text">
            <div class="alert alert-warning-light no-margin" style="font-size: 5px;padding: 8px">提现的金额不能低于100元</div>
        </div>
    </div>

    <div class="form-group c-account_name">
        <label class="control-label col-xs-12 col-sm-3">账户名:</label>
        <div class="col-xs-12 col-sm-7">
            <input id="c-account_name" class="form-control" name="row[account_name]" value="" type="text">
        </div>
    </div>

    <div class="form-group c-bank">
        <label class="control-label col-xs-12 col-sm-3">请选择银行:</label>
        <div class="col-xs-12 col-sm-7">
            {:build_select('row[bank_id]', $list, null, ['class'=>'form-control selectpicker'])}
        </div>
    </div>

    <div class="form-group c-account">
        <label class="control-label col-xs-12 col-sm-3">卡号:</label>
        <div class="col-xs-12 col-sm-7">
            <input id="c-account" class="form-control" name="row[account]" value="" type="text">
        </div>
    </div>

    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
